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Wednesday, 1 July 2020

CASE 589: TB OF TESTIS, Dr PHAN THANH HẢI-Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Male 28yo, with swelling and scrotal pain in thrombophlebitis management and spermatic vein thrombosis for 2 months but nothing change that a hospital in HCM city made decision to surgery because of not ruling out a sarcoma?

US and MRI cannot rule out a spermatic tumor.






At Medic Center utrasound detected edema of epidydimal head, hypervascular #36x24mm with some calcium nodules, scrotal skin edema and small amount of  fluid in scrotum while seldom revealed lymph nodes that are poor echoic  in necrosis and calcified  at left neck=10-31mm that made  thought about TB abscess of left epidydimis










Blood tests: WBC 10.900 / mL;  CRP 13.63 mg/L; AFP 1.94 ng/ml; BetaHCG blood < 0.2  mUI/ml.


Chest X-Rays detected fibrotic lesion in right subclavian area and suspected TB lesion of right lung.






FNAC for left neck lymph node thinks about TB node.







Pulmonary and TB PNT hospital suspected TB testis and peripheric nodular disorders.




For 4 months of TB treatment, on ultrasound in Medic Center, head of epidydimis decreases volume #24x16mm, hyperechoic pattern, non hypervascular irrigation with existing a small abscess of 16x11mm, and scrotal skin slightly thickend with small amount of fluid in scrotum.








Decreasing of volume of left neck lymph nodes =10-29mm.



TB of epidydimis is a rare entity. Ultrasound findings is painful or painless area, hypoechoic homogenous or inhomogenous pattern due to necrotized, granulomatic and fibrotic changes.

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